Nurse Peer Advocate Volunteer Training. Nurse Assistance Network Tualatin, Oregon April 10, 2015

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1 Nurse Peer Advocate Volunteer Training Nurse Assistance Network Tualatin, Oregon April 10,

2 Learning Objectives 1. Describe the role & responsibilities of Nurse Peer Advocate 2. Identify boundaries between NPA & other roles 3. State the obligation to report violations of Nurse Practice Act 4. Describe how NPA assists the nurse to identify needs and explain options 5. Recognize situations that require referral to other resources 6. List at least three relevant resources that will help the NPA provide high-value service 2

3 Module 1 NURSE PEER ADVOCATE ROLE & RESPONSIBILITIES 3

4 Statistical Picture for Nurses Substance use disorders are about the same as the general public 6% to 8% Nurses enrolled in monitoring nationwide estimated at 12,060 9,715 in alternative programs 2,345 in disciplinary programs Oregon nurses enrolled in monitoring (~ 197) 109 (with 9 self-referrals) in alternative program (HPSP) 88 in disciplinary program (OSBN probation) 4

5 Substance Use & Brain Function 5

6 History of NAN Caring for our Profession: Supporting Our Chemically Involved Peers towards Recovery April

7 NAN Mission To reach nurse colleagues before substance use or mental health problems cause impairment or before impairment becomes a danger to patients, colleagues, and the community To stimulate a network of local support resources that encourages affected nurses to adopt a personal program of recovery from substance use and mental health disorders The role of NAN is strictly one of referral and rehabilitative support and is separate from any disciplinary aspect of a licensee s practice. 7

8 ANA Code of Ethics for Nurses The nurse s duty is to: 1. Take action to protect the patient, the public and the profession from harm 2. To extend caring and compassion to colleagues throughout process 3. Advocate for appropriate assistance including support for return to practice for those who are ready Interpretive Statement 3.5 & 3.6 (2015 Update) 8

9 ANA Code of Ethics for Nurses Be alert to and take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights and best interests of the patient in jeopardy. Interpretive Statement 3.5 & 3.6 (2015 Update) 9

10 Grounding in Worksite Practice Be alert means clarify the facts when you have a concern about a team member s performance Assess the risk and consider your ethical responsibility and obligations under the law Employ organizational policies or contact the board of nursing in a timely way 10

11 11 HPSP Enrollment vs Probation

12 Duty to Report Report within 10 days any felony arrest or any misdemeanor or felony conviction Report prohibited or unprofessional conduct of any licensed healthcare professional unless state or federal confidentiality laws prohibit Conduct that constitutes a criminal act against a patient or client o That creates a risk of harm to a patient or client o Conduct unbecoming a licensee, detrimental to the public, including actions contrary to recognized standards of ethics or that endanger the public 12

13 Duty to Report Unsafe practice that results in patient harm Pattern of unsafe/incompetent practice Narcotic medication controls are violated Concerns when a colleague may not be fit to perform essential duties Say: Be careful what you tell me. I have an obligation to report. My role is to give you helpful information. 13

14 Nurse Peer Advocate Role The Nurse Peer Advocate is a trained volunteer who assists nurses to enter and maintain recovery by: Responding to inquiries Explaining options for qualified evaluation, intervention and treatment Providing other support for early recovery Building awareness of NAN services Providing education to others in the profession Facilitating nurse peer support meetings (possible future) 14

15 What Nurse Peer Advocate is Not Another perceived official role Workplace advocate, eg, unit rep or grievance chair 12 Step sponsor Therapist or counselor You can have different hats; wear only one at a time by clarifying your role 15

16 What to Avoid Wearing more than one hat at a time Giving advice rather than describing options Feeding denial by being too sympathetic Precipitating reaction by being too tough Recommending more than nurse is willing to do Anything sexually romantic (13 th stepping) Other situations you can think of? 16

17 17 BREAK

18 Module 2 RECOVERY & RECOVERY MAINTENANCE 18

19 Recovery is A process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential. Applies to substance use and mental disorders Working Definition of Recovery National Summit on Recovery Conference Report, 2005 Center for Substance Abuse Treatment 19

20 Healing Components of Recovery Body - detoxification, physical healing, brain healing Mind/emotion - hopefulness, balance and healthy management of emotions Social - re-integration and healing of relationships Spiritual meaningful connection, sense of belonging, sense of acceptance and ease 20

21 Recovery Support Research Rely on AA for support Those who quit on their own = 34% abstinent at 16 th year Those who attended at least 27 weeks of AA during first year = 67% abstinent at 16 th year Involved in treatment Those who engaged with treatment = 56% abstinent at 16 th year Those who did not seek treatment = 39% abstinent at 16 th year Treatment and recovery support matter! 21

22 I am no longer alone

23 Recovery Maintenance Build solid recovery and support network Establish daily recovery plan (priority setting) Practice communication skill development Develop knowledge and practice life skills (Recovery Maintenance Workbook) Prepare for work re-entry. Maintain recovery progress and safety documentation 23

24 40 Modules Identifying and Managing Relapse Warning Signs High-Risk Situation Identification Changing Relationships in the Family Identifying Workplace Traps The Job Search Job Interviewing Interrupting Relapse Healthy Boundaries Depression Surviving Loss Managing stress Anger and PTSD Becoming Clear-Financial Wellness The Twelve Steps Sponsorship Domestic Violence Safety Plan Meditation Keeping our Commitments Fresh and more

25 Support Network OSBN/HPSP Case Manager Nurse Advocate Self-Help!2-step Nurse Worksite Monitor Sponsor Treatment Provider Others?

26 Criteria for Re-Entry G. Douglas Talbott, MD supportive spouse or significant other acceptance of the chronic nature of substance use disorder well grounded in the recovery community (meetings, sponsor) willingness to commit to monitoring as recommended established workplace policies and supportive colleagues (AANA, 2009) 26

27 Returning to Work Typical OSBN limitations How does discipline impact my job search? When to disclose enrollment in monitoring at a job interview? Employer expectations, for example, attendance, adherence to monitoring agreement etc. 27

28 Returning to Work Trust Accountability Communication Support Safe Practice 28

29 What s different/similar between my professional role and Nurse Peer Advocate role? Practice and Discussion 29

30 30 BREAK

31 Module 3 GUIDELINES & COMMITMENTS 31

32 Sources of questions Inquiries Nurse Colleagues Family Employer Channels Face to face NAN Response Line 32

33 NAN Response Line Since March 2013 we have had 28 responses to inquiries (~1 per month) Types of Questions/Inquiries - HPSP & Discipline Program Questions - Connect to a Peer support group - Legal questions - Counseling & Treatment questions 33

34 Tough Issues Employment questions Questions about license Legal problems Financial costs Support groups and sponsors 34

35 Ground Rules Explain that the Nurse Peer Advocate role is to help identify the nurse s needs and relevant options; not to give advice. Clarify the options and state: The choice is yours. Duty to report unsafe/unprofessional behavior by another health professional I went to work last night under the influence Provide fair warning: Be careful what you disclose to me. When there is a need to report a situation to the board Offer self-disclosure: I will offer you 24 hours to report yourself. 35

36 Referral Resources NAN Response Line: OSBN Website: Impaired Provider Monitoring Nurse Assistance Network web page I need help I m curious about recovery I m in recovery Stories of recovery Qualified clinical evaluation and treatment providers Tom Doyle (Bennett-Hartman Attys):

37 What if a Crisis Develops? Unlikely Comes to you under the influence Suicidal (hotline) Becomes aggressive (Defusing statements; security; meet in a safe environment not isolated; resources at hand) 37

38 Other Resources Local recovery resources Professional Recovery Network (PRN) Bibliography of relevant research WorkHealthy Oregon blog 38

39 What do I bring to the advocacy role & what else do I need to be effective? Reflection and Application 39

40 Job Description Written guidelines Recommend professional liability insurance Helping the resources grow Other roles in the community Education at local school of nursing Resource where you work Recruit a larger support network 40

41 Training Evaluation for CEU s Thank you! 41

42 HPSP: Alternative to Discipline 2009 law to protect patient safety by alternative to discipline - Health Professionals Services Program Nurses, physicians, pharmacists, and dentists Both board-referral & self-referral (+$1,500 safe practice evaluation for self-referrals) Independent evaluation ($300-$1,500) and treatment ($) Substance use & mental health disorders only 4 years for substance use; 2 years for mental health Employer must meet supervisor training standard Monthly supervisor report Random drug screening ($2,400 per year) 42

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